Healthcare Provider Details

I. General information

NPI: 1013246966
Provider Name (Legal Business Name): REGROUP WITH PRINCETTA'S BEHAVIORAL HEALTH SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARK AVE STE 7
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

PO BOX 512
FANWOOD NJ
07023-0512
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-3392
  • Fax:
Mailing address:
  • Phone: 908-755-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. PRINCETTA A. EDWARDS
Title or Position: PSYCHOTHERAPIST/PRESIDENT/CEO
Credential: LCSW
Phone: 908-755-3392